β-受体阻滞剂在心力衰竭中的作用

分析总结β-受体阻滞剂在心力衰竭治疗中的作用。     

β受体阻滞剂治疗慢性心力衰竭研究进展

慢性心力衰竭患者的交感神经系统活性增强 ,随着病程的延长可导致心血管系统功能恶化 ,β受体阻滞剂可通过抑制神经内分泌的活性而预防病情恶化。近年来有研究表明 ,合理使用 β受体阻滞剂可有效改善心力衰竭患者的预后。     

β受体阻滞剂与心力衰竭

β受体阻滞剂与心力衰竭第三军医大学西南医院彭玲综述何国祥审校本世纪以来，心衰的治疗决策经历了四个不同的阶段，尤其八十年代以来β受体阻滞剂用于治疗心衰，提高了心衰病人的远期生存率，降低了病死率。本文就β受体阻滞剂治疗心衰的理论依据和临床应用技巧综述如下...     

β受体阻滞剂治疗充血性心力衰竭药物利用分析

目的 了解充血性心力衰竭（CHF）治疗中β受体阻滞剂使用现状，提高用药水平。方法 对一年来广东省医院心内科、心外科986例CHF病例作横断面调查，依据CHF治疗指南结合最新循证医学的证据对用药情况作客观评估。结果 美托洛尔、卡维地洛、比索洛尔分占1-3位，其他药物很少使用。结论 反映了近几年来国内外在CHF药物治疗方面的新认识和新进展，但在心功能失代偿的住院病人中存在一定的滥用倾向。     

β受体阻滞剂治疗充血性心力衰竭临床观察

目的　观察β受体阻滞剂治疗心力衰竭的疗效。方法　 80例心力衰竭患者随机分为两组 ,治疗组在对照组常规强心、利尿、扩血管的基础上加用β受体阻滞剂 ,治疗 8周后观察患者临床症状、心率、心功能改善情况。结果　治疗组各项指标均明显改善 ,患者生活质量明显提高。结论　β受体阻滞剂治疗心力衰竭安全有效     

β受体阻滞剂在心力衰竭治疗中的新概念

心力衰竭(HF)是一种常见的临床综合症,是各种病因心脏病的严重阶段.20世纪60年代利尿剂的问世,使浮肿得到有效控制;20世纪70年代,血管扩张剂治疗心力衰竭效果得到公认[1];80年代,ACEI与β-受体阻滞剂的应用,开创了心衰治疗研究的新纪元[2].大量临床RCTs证明,β-受体阻滞剂不但能改善心肌重塑,提高患者生活质量,还能降低心衰死亡率[3,4].     

β受体阻滞剂治疗心力衰竭的安全性研究进展

充血性心力衰竭(congestive heart failure，CHF)是心血管疾病死亡的主要原因。近年来由于认识到神经内分泌过度激活在心力衰竭发生和发展过程中的作用和ACEI类药物的广泛应用，心力衰竭患的预后已经有了明显的改善．但心衰患仍面临高死亡率的威胁。如何进一步提高心衰治疗的效果成为一个人们广泛关注的问题。自Waagstein1975年报道     

β受体阻滞剂在心力衰竭治疗中的应用

β受体阻滞剂是治疗心力衰竭的基本药物.然而,在临床上恰当使用β受体阻滞荆则是困惑着大家的重要问题.一方面.心力衰竭指南已经根据循证医学证据为我们确定了临床应用的大方向;另一方面,如何合理的个体化应用又是实际存在的棘手的问题.因此,在临床上正确理解指南并在指南的基础上结合临床实际,个体化的调整β受体阻滞剂用药,将会使患者获得最大的治疗效果.     

β受体阻滞剂在慢性心力衰竭的治疗进展

随着近年来的几个大规模临床试验研究结果的发表 ,β受体阻滞剂在慢性心力衰竭治疗中的地位已经确立 ,是心力衰竭的标准治疗药物之一。本文即就有关问题作一介绍。1　慢性心力衰竭的病理生理机制既往认为心力衰竭只是一种血流动力学障碍性疾病 ,即由于心肌收缩力减退 ,致前向血流减少和肺静脉系统血流回流障碍 ,而交感神经系统及肾素血管紧张素系统 (ＲＡＳ)的激活起代偿作用。但很遗憾的是 ,针对增强心肌收缩力或降低后负荷的治疗研究并没有显示能改善心力衰竭患者的预后。相反 80年代发表的针对ＲＡＳ的两个大规模试验 (ＣＯＮＳＥＮＳＵ…     

β受体阻滞剂治疗慢性心力衰竭合并慢性阻塞性肺病

心力衰竭合并慢性阻塞性肺病发病率及致死率随着年龄增长而升高。尽管β受体阻滞剂治疗心力衰竭明确的有效性,但临床医生由于担心其引起的气道高反应性和气道痉挛而避免在心力衰竭合并慢性阻塞性肺病患者中应用该类药物。然而,越来越多的证据表明,心脏选择性β受体阻滞剂在慢性心力衰竭合并慢性阻塞性肺病患者中没有明显的不良反应,且安全性得到证实,没有证据显示其降低肺通气功能,如1秒末呼气量。     

Beneficial effect of carvedilol on heart rate response to exercise in digitalised patients with heart failure in atrial fibrillation due to idiopathic dilated cardiomyopathy

Fourteen digitalised patients diagnosed with heart failure (NYHA Functional class II) with idiopathic dilated cardiomyopathy in chronic established atrial fibrillation were administered carvedilol in addition to their anti-heart failure medications in an attempt to improve their heart rate control. Fourteen matched patients who did not receive carvedilol acted as control subjects. Patients treated with carvedilol showed significantly reduced resting heart rates (10-36%), maximal heart rates on exercise (5-20%) and an increased exercise time (2-30%) on treadmill stress tests (all P=0.001). Ventricular ectopic activity was also diminished. This was associated with symptomatic improvement in effort intolerance and palpitations. NYHA functional class, left ventricular dimensions and ejection fractions did not improve during the study period of 3 months. Thus, addition of carvedilol to digoxin had a beneficial effect on exercise tolerance in patients with idiopathic dilated cardiomyopathy in atrial fibrillation by virtue of an improved heart rate control both at rest and on exercise. Carvedilol was well tolerated despite impaired myocardial function.     

胺碘酮治疗心衰并发房颤的有效性和安全性研究

评价胺碘酮对心衰并发房颤患者心室率的影响，转复窦性心律的可能性，以及治疗的安全性。采用随机、单盲、安慰剂对照方法，运用２４ ｈ 动态心电图监测心率。结果:①胺碘酮对心衰并发房颤患者的转复律为２３．５３％ ，高于对照组（３．３３％ ），Ｐ＜ ０．０１。②治疗２ 周后试验组１２ 导联心电图所得平均心室率、Ｈｏｌｔｅｒ监测下２４ ｈ 最大心室率、平均心室率明显下降（Ｐ＜ ０．０１），最小心室率无影响（Ｐ＞ ０．０５）。③两组间左室射血分数（ＬＶＥＦ）无差异（Ｐ＞ ０．０５），均无尖端扭转性室性心动过速发生，试验组ＱＴｃ延长，但改为维持量后ＱＴｃ恢复正常。结论:胺碘酮能使一部分心衰并发房颤患者复律，并且无论复律与否，均能减慢心室率，而不影响心功能的改善，严重副反应较少发生     

Anti-thrombotic strategies for patients with atrial fibrillation and heart failure

Atrial fibrillation occurs commonly in the setting of congestive heart failure and, in fact can cause left ventricular dysfunction due to a rapid ventricular response over time, termed tachycardia-mediated cardiomyopathy. The combination of atrial fibrillation and congestive heart failure leads to a high risk of stroke for the patient and appropriate antithrombotic therapy can minimize this incidence of stroke. Stroke risk can be markedly reduced by treatment with warfarin and complications of anticoagulation minimized by close attention to maintaining the INR between 2.0 and 3.0.     

Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure

BACKGROUND: Congestive heart failure (CHF) is characterized by neurohormonal activation, including increased plasma concentrations of atrial natriuretic peptide (ANP) and N-terminal ANP (N-ANP). Onset of atrial fibrillation (AF) further increases these peptides, but it may be hypothesized that concentrations decrease during longstanding AF due to inherent atrial degeneration. AIM: We sought to investigate the relation between neurohormonal activation in patients with CHF and the duration of concomitant AF. METHODS: The study group comprised 60 patients (age 70 +/- 8 years) with advanced CHF due to left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF) < 0.35) and chronic AF (duration 21 (1-340) months). Plasma neurohormone concentrations were measured, and multiple regression analysis was performed to identify their clinical predictors. RESULTS: Median plasma neurohormone concentrations were: ANP 113 pmol/l, N-ANP 1187 pmol/l, norepinephrine 496 pg/ml, renin 127 micro units/l, aldosterone 128 pg/ml and endothelin 8.1 pg/ml. Norepinephrine, renin, aldosterone and endothelin were not significantly related to the duration of AF. In contrast, ANP decreased along with the duration of AF (P = 0.03), while the same trend was observed for N-ANP (P = 0.10). However, for these peptides a first order interaction with LVEF was present, which was not observed in the other neurohormones. In patients with LVEF > 0.25 ANP and N-ANP increased along with the duration of AF, whereas in patients with LVEF < or = 0.25 an inverse relation between ANP (P = 0.02) and N-ANP (P = 0.04) and the duration of AF was present, longer-standing AF being associated with lower concentrations. CONCLUSION: In patients with advanced CHF with low LVEF plasma ANP and N-ANP concentrations decrease during longstanding AF. This finding agrees with the concept that longstanding AF leads to impaired ability of the atria to produce these neurohormones due to inherent degenerative changes.     

Impact of atrial fibrillation on mortality in patients with chronic heart failure

Chronic heart failure and atrial fibrillation often occur together. The aim of the study is to review the available literature on the impact of atrial fibrillation on mortality in patients with heart failure. Using MEDLINE six full papers were identified. In the studies with severe heart failure atrial fibrillation did not emerge as an independent predictor of mortality beyond standard clinical variables. In contrast, atrial fibrillation was associated with increased mortality in case of mild-to-moderate heart failure.     

胺碘酮治疗老年充血性心力衰竭伴快速房颤的疗效观察

目的 观察胺碘酮治疗老年充血性心力衰竭（CHF）伴快速心房纤颤（AF）的疗效。方法　选择2012年9月至2013年9月在苏北人民医院住院治疗的老年CHF伴快速AF患者70例,纽约心脏联合会分级（NYHA）Ⅱ～Ⅳ级,心室率≥120次/min;随机分为胺碘酮组和去乙酰毛花苷组,每组各35例。在常规治疗基础上,胺碘酮组首次剂量给予胺碘酮150mg缓慢静注,随后1.5mg/min微量泵维持;去乙酰毛花苷组首次剂量给予去乙酰毛花苷0.4mg或0.2mg缓慢静注,1h后无效者追加0.2mg。观察用药后不同时刻的心室率变化、药物平均起效时间、复律成功比例、B型利钠肽（BNP）变化、不良反应及随访效果。结果 两组患者用药后1,2,24h的心室率与用药前比较差异有统计学意义（P＜0.01）,胺碘酮组用药后30min的心室率与用药前比较差异亦有统计学意义（P＜0.01）;用药后2h胺碘酮组患者心室率较用药前下降47%, 去乙酰毛花苷组下降28%;胺碘酮组与去乙酰毛花苷组用药后30min,1h,2h,24h心室率间差异有统计学意义（P＜0.01）;胺碘酮组和去乙酰毛花苷组的治疗有效率分别为79.8%和72.3%（P＞0.05）; 胺碘酮组和去乙酰毛花苷组的复律成功率分别为34.3%和8.6%（P＜0.01）;两组患者间BNP变化差异无统计学意义（P＞0.05）;出院3个月后随访,两组患者治疗后（口服药物包括可达龙、美托洛尔、地高辛）仍为AF的比率分别为60.0%（21/35）和82.9%（29/35）;而不良反应发生率分别为8.6%和11.4%（P＞0.05）。结论　胺碘酮是治疗老年CHF合并AF有效的药物之一,副反应轻,使用安全。     

慢性心力衰竭患者血尿酸水平和房颤的关系

目的 分析慢性心力衰竭（CHF）患者血尿酸（SUA）水平与房颤（AF）的关系。方法 回顾性地分析2010年1月至2014年2月期间在商洛市中心医院心血管内科住院的218例CHF患者的人口学资料、既往相关病史、血液生化指标、超声心动图及颈部血管超声结果。根据是否AF将218例患者分为AF组和窦性心律组。结果 218例患者中,有49例合并AF,169例为窦性心律,AF发生率为22.5%。与窦性心律组相比,SUA水平在AF组明显升高。AF组的年龄比窦性心律组更高[（64.32±9.87） vs （56.78±10.14）岁,P＜0.05。];射血分数前者比窦性心律组低,差异有统计学意义（P＜0.05）;而包括左心房内径、左心室舒张末内径、左心室收缩末内径等在内的超声心动图参数,AF组比窦性心律组高;颈动脉内膜中层厚度AF组也明显高于窦性心律组（P＜0.05）。多因素logistic回归分析显示,SUA水平为发生AF的独立危险因素。结论 AF组患者有更高的SUA水平和更差的心功能。     

心房颤动合并心力衰竭的治疗进展

心房颤动（房颤）与心力衰竭（心衰）常同时存在,二者互为因果,并导致住院率、致残率和病死率明显增加。目前的基本治疗策略仍是预防血栓、改善症状。研究表明,接受房颤导管消融治疗的房颤合并心衰患者能够增加左室射血分数、改善生活质量及降低住院率,但仍需进一步的研究。识别房颤对于心功能不全的影响对治疗十分重要。     

Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation

OBJECTIVE—To investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm.DESIGN—Non-randomised controlled trial; cohort; case series; mean (SD) follow up duration 3.4 (1.6) years.SETTING—Tertiary care centre.SUBJECTS—Consecutive sampling of 342 patients with persistent atrial fibrillation (defined as > 24 hours duration) considered eligible for electrical cardioversion.INTERVENTIONS—Serial electrical cardioversions and serial antiarrhythmic drug treatment, after identification and treatment of underlying cardiovascular disease.MAIN OUTCOME MEASURES—heart failure complications: development or progression of heart failure requiring the institution or addition of drug treatment, hospital admission, or death from heart failure.RESULTS—Development or progression of heart failure occurred in 38 patients (11%), and 22 patients (6%) died from heart failure. These complications were related to the presence of coronary artery disease (p < 0.001, risk ratio 3.2, 95% confidence interval (CI) 1.6 to 6.5), rheumatic heart disease (p < 0.001, risk ratio 5.0, 95% CI 2.4 to 10.2), cardiomyopathy (p < 0.001, risk ratio 5.0, 95% CI 2.0 to 12.4), atrial fibrillation for < 3 months (p = 0.04, risk ratio 2.0, 95% CI 1.0 to 3.7), and poor exercise tolerance (New York Heart Association class III at inclusion, p < 0.001, risk ratio 3.5, 95% CI 1.9 to 6.7). No heart failure complications were observed in patients with lone atrial fibrillation.CONCLUSIONS—Aggressive serial electrical cardioversion does not prevent heart failure complications in patients with persistent atrial fibrillation. These complications are predominantly observed in patients with more severe underlying cardiovascular disease. Randomised comparison with rate control treatment is needed to define the optimal treatment for persistent atrial fibrillation in relation to heart failure.     

心脏再同步化治疗顽固性心力衰竭合并心房颤动

目的总结心脏再同步化治疗(CRT)合并心房颤动(房颤)的心力衰竭(心衰)的疗效,分析这类患者CRT反应的可能原因。方法 2003年3月至2007年3月接受CRT合并房颤的难治性心衰患者5例,4例为扩张型心肌病,1例为缺血性心肌病,NYHA心功能Ⅲ～Ⅳ级。4例经冠状窦途径成功置入左室电极,1例冠状窦途径失败后行右室双部位起搏(流出道间隔部和心尖部)。结果术后平均随访(12±13)个月,所有患者术后临床症状均有不同程度的改善,NYHA分级提高0+～2级;生活质量和活动耐力均有改善。平均双室起搏比例(90±9)%,其中第2、4、5例术后频发室性早搏,平均双室起搏比例偏低(77%～83%)。第2例加用胺碘酮后比例由83%升至95%,NYHA分级提高2级。5例患者先后于术后1～33个月死亡,直接死亡原因为室性心律失常者2例,心衰恶化者3例。结论 CRT同样可以使合并持续性房颤的难治性心衰患者受益,可以提高生活质量、活动耐力。保证完全的双室起搏是合并房颤的心衰患者对CRT反应的关键因素之一。合并房颤的难治性心衰患者可能更需要在严重心衰早期积极地选择CRT。部分合并房颤的难治性心衰患者,在行CRT同时应考虑植入除颤器。